Intracranial Hemorrhage

Intracranial Hemorrhage ICH
[ ] Elevate HOB 30 degrees
[ ] Mannitol 1.5-2 mg/kg if edema, shift or herniation
- reduces ICP 50% in 30 minutes, peaks after 90 minutes, and lasts 4 hours
[ ] +/- Lasix 40 mg IV
- potentiates Mannitol effect to dec ICP w/o raising osms
[ ] No tape tourniquet around neck
[ ] ABG 5-15 mins s/p intubation or ETCO2 monitoring
- target pCO2 30-35
WHAT ABOUT ETCO2
[ ] If hydrocephalus or cerebral aqueduct occlusion: EVD (emergent ventriculostomy drain)?
[ ] Coags & platelets
[ ] Elev INR on Warfarin?
- Vitamin K 10 mg IV over 10 minutes
- Prothrombin Complex Concentrate
* Bebulin, or Profilnine, 50 units / kg over 20 min
* FEIBA
* Kcentra (Beriplex)
- If no PCC available, give FFP 15 cc/kg
[ ] Elev INR with liver failure?
- Same as above but always need FFP, give 2 units
[ ] Platelet dysfx secondary to uremia, ASA, Plavix?
- dDAVP 0.3 mg/kg IV (20 mcg in 50 cc NS) over 15-30 mins
- 1 donor pack of platelets (debatable with Plavix)
[ ] +/- Labetolol or Nipride or Nicardipine (Cardene) for SBP < 140 prior to tx
- Labetolol: 20-30 mg IV over 2 min followed by 40-80 mg at 10-min intervals; not to exceed 300 mg/dose
- Nipride: 0.5 mcg/kg/min IV titrate by 0.5 to effect
- Nicardipine 5-15 mg/hr IV, titrate by 2.5 mg
[ ] +/- pressors for SBP > 120
[ ] Acetaminophen 650 mg PO/PR for normothermia
[ ] insuling for hyperglycemia

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